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John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve seen a bunch of different websites listing the top 10 EHR vendors based on physicians who attested to meaningful use using their EHR software. This list is certainly interesting and worthy of a discussion. However, I think it’s also important to put these numbers in some context. Remember that these numbers are just for the ambulatory EHR space. The Hospital EHR numbers are a different story which I’ll probably cover on Hospital EMR and EHR.

Here are the EHR incentive numbers by EHR vendor and also the percentage of meaningful use attestations they had (Thanks to Dr. Rowley for the numbers):

EHR Vendor

MU Attestations

Percentage

Epic

11075

23%

Allscripts

5743

12%

eCW

4057

8%

NextGen

2237

5%

GE

2002

4%

Athena

1733

4%

Greenway

1650

3%

Cerner

1375

3%

MEDENT (Previously Community Computer Service)

1264

3%

e-MDs

1235

3%

Practice Fusion

1156

2%

Sage

1140

2%

Other EHRs (272)

14358

29%

As Dr. Rowley points out in his post, Epic is the largest vendor on the list, but they don’t market or sale their product to independent clinics or even independent physician groups. Epic’s ambulatory EHR is found in owned or affiliated clinics who use the ambulatory piece of the EHR an Epic hospital buys. So, the above Epic number actually provides an insight into how many ambulatory practices are associated with Epic using hospitals.

The numbers tell an interesting story if you take Epic out of the mix:

EHR Vendor

MU Attestations

Percentage

Allscripts

5743

15%

eCW

4057

11%

NextGen

2237

6%

GE

2002

5%

Athena

1733

5%

Greenway

1650

4%

Cerner

1375

4%

MEDENT (Previously Community Computer Service)

1264

3%

e-MDs

1235

3%

Practice Fusion

1156

3%

Sage

1140

3%

Other EHRs (272)

14358

38%

Once you take out the hospital dominance in the ambulatory market, the EHR market share for any one EHR vendor is quite small. In fact, the other EHR vendor category has 38% of the EHR market. The long tail of EHR software is definitely at play right now.

Plus, we have to be really careful using meaningful use attestation as a proxy for the EHR market. I recently saw a figure that only 20% of the ambulatory EHR market had attested to meaningful use. That’s right, the above numbers only represent 20% of the ambulatory market.

If my math is correct, that still leaves almost 200,000 providers that aren’t represented in the above analysis of 50k providers. Imagine an EHR vendor comes along that’s so great that they quickly capture only 20% of the 200,000 uncounted providers (no small feat). That would give them about 40,000 providers and using the above numbers they would have 45% of the EHR market (including Epic).

Of course, the current EHR vendors will continue to sale EHR software and many will switch EHR software vendors during that time as well. Plus, no doubt many of those who haven’t attested to meaningful use already have an EHR, but aren’t represented in the numbers above. They just either don’t care about meaningful use and EHR incentive money or they’re still working to get to the point where they can attest to meaningful use. However, I still think the above numbers illustrate that there’s plenty of opportunity available for an upstart EHR company to get plenty of EHR market share.

It’s going to be an exciting next couple years as we watch all of this shake out. We’ll take a look back at this post in a few years to see how far we’ve come.

But there’s been very little effort to interconnect these institutions and affiliated physician practices. Even during the RHIO heyday of 2004-07, I don’t recall much interoperability talk in the Chicago area. (In fact, one family physician, Dr. Stasia Kahn, in far west suburban St. Charles, got so frustrated that she formed her own group to promote EMR adoption and health information exchange, Northern Illinois Physicians for Connectivity. I had heard talk for a while of some south suburban hospitals joining in an HIE with counterparts across the state line in Northwest Indiana since Illinois was moving too slowly.)

All of that non-action at the state and regional levels happened under the not-so-watchful eye of one Gov. Rod Blagojevich, who apparently was more preoccupied with his own vanity and “giving healthcare to kids” (while also allegedly trying to blackmail the CEO of Children’s Memorial Hospital into donating to his campaign fund and also slowing Medicaid payments to pay for his All Kids program) than in, you know, actually improving healthcare for everyone by promoting HIE.

In February 2009, shortly after Blagojevich was removed from office and a couple weeks before the federal American Recovery and Reinvestment Act became law, new Gov. Pat Quinn signed a law allocating $3 million to the state’s Department of Healthcare and Family Services for HIE planning. That laid the groundwork for this week’s widely publicized announcement that the not-for-profit Metropolitan Chicago Healthcare Council had chosen technology from Microsoft, Computer Sciences Corp. and HealthUnity to build what could be the largest big-city HIE in the country, potentially serving 9.4 million people in nine Illinois counties and small parts of Indiana and Wisconsin.

I bring all of this up because I met yesterday with executives from the Metropolitan Chicago Healthcare Council, a 76-year-old coalition of healthcare organizations in and around the city. It just so happened that the 2011 Microsoft Connected Health Conference was in town this week, so it was the perfect time and location for Microsoft to drop the news. According to MCHC Vice President Mary Ann Kelly, more than 70 percent of the council’s 150-some members have made a commitment to participate, and they seem to have a plan to make the HIE effort sustainable.

The exchange will operate on a subscription model, with the vendors taking on some of the risk, Kelly said. “The subscription fee will be based on the benefit each member derives,” Kelly explained.

Initially, the exchange will involve 22 hospitals in nine organizations, said Teresa Jacobsen, the council’s HIE director. “We want to get one or two use cases running first,” she said. They will start by linking emergency departments to exchange clinical summaries and for syndromic surveillance, according to Jacobsen. Once that’s going, the HIE plans on adding medication and allergy lists, diagnostic testing results and Continuity of Care Document reports, as well as additional elements for public health, including immunization records.

It all sounds great, and it’s a good idea for them to start slowly, but I wonder when and if smaller physician practices will get involved. My own physician has had an EMR for a while, but not every doctor in the practice uses it. (The four-physician practice recently upgraded to the Meaningful Use Edition of Sage Intergy and has started the 90-day clock for qualifying for Stage 1 Medicare incentives this year, but there’s essentially zero interoperability with other healthcare entities, unless you consider faxing records to others straight from a computer interoperability. I sure don’t.)

My guess is that scenarios like this are playing out all over the country. I wish them luck, but I’m not counting on nationwide interoperability for many years. For one thing, the federally funded, state-chartered Illinois HIE Authority held its very first organizational meeting Wednesday afternoon. “That’s the biggest wild card we don’t know,” MCHC CFO Dan Yunker said.

It’s key to getting payers—particularly Illinois Medicaid—on board with HIE and linking metropolitan exchange networks across the state and beyond. “Our hospitals in Chicago are responsible for the snowbirds who are in Naples (Florida),” Yunker noted. They’re also responsible for patients who come from places like Rockford, Springfield, Champaign, Carbondale and the Quad Cities for certain specialized services only available in the big city.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s going to take a couple weeks to really process all that I saw and heard at HIMSS 2011. In fact, there’s no doubt that much of the content I publish over the next month or two will be things I learned from the people I learned from at HIMSS or influenced by what I saw and heard. However, after a good night’s sleep in my own bed I’m really happy with my experience at HIMSS. The energy and passion for healthcare IT that was found at HIMSS was really powerful and wonderful to be apart of.

I think those people out there that are asking if we’re in a healthcare IT bubble right now are on the mark. There’s very little doubt in my mind that we’re in a healthcare IT bubble. It’s a feature of $36+ billion in EHR incentive money being given out by the government. I can’t remember the size of the EMR market numbers off the top of my head, but $36 billion in money coming into what is a relatively small market is going to change things dramatically. So, it makes sense that this type of infusion of money would create a bubble of sorts.

One person in their comments that we’re in a healthcare IT bubble asked if the bubble would pop before HIMSS 12 in Las Vegas. I believe we have at least one or two more years before the healthcare IT bubble pops. In fact, if you thought that HIMSS 11 in Orlando was big, I predict that HIMSS 2012 in Las Vegas will be even bigger. The EHR incentive money will have started flowing and the trench battles will be in full swing as the 300+ EMR vendors battle each other for customers.

EMR software was obviously my focus at the conference and despite my comments about the lack of innovation by EMR vendors and the future of EMR, I think there are a ton of really interesting EMR approaches that in aggregate are going to impact the EMR world in really dramatic ways. Here’s some examples:

Azzly described a meeting of EHR vendors they attended with ONC. The question was asked which EHR vendors in the room started development after the HITECH act was announced. Azzly was the only one to raise their hand. I’m sure there’s other EHR vendors in that same boat, but it will be interesting to see an Azzly EHR that was built post incentive go up against the legacy EHR software.

ClearPractice was the first native iPad EMR (called Nimble) that I’d seen and there’s no doubt they’ve made a big play in that space. Will that combined with the backing of John Doerr and their internet driven sales change EMR as we know it?

Will larger companies like Greenway and Sage continue to gain market share as they go after the EMR market while maintaining their customer experience? Or will they head the way of the Misys of the world and be bought up by other EMR vendors?

What about NaviNet‘s entrance into the EMR world? Can they leverage their existing connections with so many providers to be a major player in not just interoperability but in EMR as well?

Even the big behemoth of a company, GE surprised me when I visited with them. There was a polish and a professionalism that I loved about my visit with GE and GE’s Centricity Advance people. I think there’s a fair comparison with Microsoft. Something about the nature of the US loves the underdog and hates the big name player. Yet, the big company just keeps executing their vision and many doctors are going to happily buy and use their products.

What about Ingenix‘s multiple EMR offering strategy? Will it just be confusing to clinicians or will they effectively differentiate their various offerings while providing a backbone for interoperability as well? Is the future large EMR vendor one that aggregates a bunch of niche specific EMR companies?

Many people probably don’t recognize the name MedPlus. However, everyone knows the company behind the MedPlus Care360 EMR: Quest Diagnostics. There’s something powerful about being able to turn on an EMR in a medical practice with basically the flip of an electronic switch. That’s what MedPlus can do since Care360 is already being used in so many clinics that use Quest for their lab work. Add in their existing lab sales staff that already have relationships with large numbers of clinics and they’re going to be a very interesting player in the EMR space.

Free EMR is a really compelling marketing tool. There’s a reason that Practice Fusion and Mitochon Systems free EMR offerings get so much press and so many doctors evaluating their EMR offerings. While many might disagree with their model or even believe that it will fail, these companies have and will have an interesting impact on the EMR landscape.

MicroMD offers an interesting approach. First, because of their existing LONG term practice management clients. Second, because of the interesting integration with the supply side of their company. Not to mention, the executives that I met with were some of the most realistic people and well thought out people I met at HIMSS.

Props to EMR company MIE that could use a fake EMR company (Extormity) to launch themselves into the EMR discussion while also helping to open up the discussion as well. If I were a doctor, I’d want to demo their EMR just so I could see if I could find any Extormity features in their EMR. Although, maybe that’s just the blogger in me.

I could keep going on, but that gives you a bit of flavor of some interesting EMR vendors and their market approaches. Plus, this is just 16 of the 300+ EMR companies that are working in this space. Each one with their own interesting story.

The most exciting thing for an EMR nerd like myself is that we’re really only at the beginning. Wait until we get beyond 15-25% adoption and reach 50% adoption. Then, the fun really begins.

Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use,
ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!

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